Age Time Research Articles

Effect of physiological and environmental factors on mosquito wingbeat frequency.

Wingbeat frequency may serve as a distinctive physical signature for identifying mosquito species. However, variation in wingbeat frequency within species may compromise reliability of wingbeat frequency-based mosquito identification. We examined the impact of mosquito density (number of females), time of day (day or night), gravid status, and age (days post-emergence) on the wingbeat frequency of three important vector mosquito species using infrared optical sensors. Wingbeat frequency of Culex quinquefasciatus was significantly higher (6.2% and 9.5%) for single females compared to groups of five and ten females, respectively, and 9.4% higher during the daytime compared to nighttime. Wingbeat frequency was also significantly higher for gravid Cx. quinquefasciatus (9.4%) and Aedes aegypti (1.4%) than nongravid conspecifics. Within a short age range (five to seven days post-emergence), wingbeat in Cx. quinquefasciatus did not vary significantly. Our results highlight that both extrinsic (density and time of day) and intrinsic (gravid status) factors contribute to wingbeat variation, potentially posing challenges for development of wingbeat profile libraries and the classification of unknown specimens. Traps that aim to use wingbeat frequency and target specific cohorts of the population (i.e., host-seeking or gravid females) will need to account for differences in wingbeat frequency due to multiple factors.

Thinking about the future in older age

Older age is often conceptualised as a stage of life in which the future is considered to be less relevant than the past. This is reflected in literature that emphasises the importance of the past in later life but overlooks the significance of the future. This paper addresses this knowledge gap by analysing narratives that older people write about the future. We do this through secondary analysis of diary entries written by older respondents to the British Mass Observation Project in 1988, in response to a directive about time. The aim of our analysis was to develop conceptual understandings of the relationship between older age and future time. Our thematic analysis identified four main orientations that respondents had towards the future: dreading the future; time running out; taking one day at a time; thinking beyond finitude. Underpinning all of these was a reluctance to contemplate and plan for changes in physical and cognitive health and future care needs, a finding echoed in more recent research. Drawing on critical time perspectives that foreground the fluid, complex and social nature of time, we suggest that reluctance to acknowledge and plan for the future in later life reflects conceptualisations of the future as unpredictable and inseparable from past and present temporalities. This contrasts with more instrumentalist ageing discourses that imply the future can be ‘managed’ from the present. We conclude by calling for a greater repertoire of how we imagine and narrate the future in later life.

Role of intra-individual variation in the detection of thresholds for DFI and for misclassification rates: A retrospective analysis of 14,775 SCSA® tests.

Sperm DNA damage is associated with reduced male fertility after natural conception and intrauterine insemination. However, the impact on in vitro fertilization (IVF) and especially intracytoplasmic sperm injection (ICSI) treatments is still unclear. Few studies have focused on the intra-individual variation in DFI even though it may have an important role to play in terms of detection of thresholds and for misclassification rates. Results for Sperm Chromatin Structure Assay (SCSA®) tests performed for 70 European fertility clinics between January 1st, 2008 and December 31st, 2022 were examined. A small retrospective study included 406 couples receiving their first treatment with IVF or ICSI. These results were then used for a mathematical simulation to investigate the role of intra-individual variation. The large retrospective study included a total of 14,138 diagnostic tests and 637 tests from an IUI study. The distribution of DFI was assessed for the IUI cohort and cohorts of patients attending Sims IVF and Fertility Center Hamburg (FCH). Descriptive analysis of the data was performed regarding time of year, male age, and year. When DFI was above the thresholds of 15 and 25, a significant reduction in ongoing pregnancies after 12weeks of gestation was observed for IVF and ICSI treatments, respectively. For IVF treatments, the pregnancy rate was reduced from 45.1% to 24.6%, odds ratio=2.58 (p=0.004). For ICSI treatments, the pregnancy rate was reduced from 48.6% to 29.6%, odds ratio=2.00 (p=0.032). Intra-individual variation was significantly related to the misclassification rate and the sample size required to identify a threshold. The percentage of patients with a DFI below 15 was 64.8% for the IUI cohort and 51.7% and 41.6% for cohorts of patients attending Sims IVF and FCH, respectively. The median DFI for these cohorts differed significantly and was 11.6, 15.0 and 17.2, respectively. DFI shows a seasonal variation, and increases with male age. During the past 15 years, the median DFI has increased by 0.05% per year (p=0.02). Ongoing pregnancy rates are reduced significantly for both IVF and ICSI treatments when DFI is above the thresholds of 15 and 25, respectively. The misclassification rate and the required sample size increase with increasing intra-individual variation. Couples with a DFI above 15 are more likely to experience failed assisted reproductive technology(ART) cycles. DFI appears to have increased during the past 15 years.

HPB SO65 - An audit of the day-case rate of laparoscopic cholecystectomies at a busy district general hospital and factors affecting this

Abstract Background The target day case rate of laparoscopic cholecystectomies at a busy district general hospital is 75%, as per Model Hospital Guidelines. The current rate at which day cases are achieved is 55%. This audit aims to identify factors relating to the DGH not reaching their day case target and explore potential solutions for these, with the intention to reduce patient’s hospital stay and, therefore, overall costs. Method 119 patients had undergone a laparoscopic cholecystectomy in the first five months of 2024. Exclusion criteria included hot cholecystectomies, common bile duct explorations and planned admissions. The remaining 85 patients were included in this audit. The data proforma included age, ASA, BMI, co-morbidities, Nassar grade, scheduled and actual time of operation and any reasons for delay. Results Of the 85 patients included in this audit, 34% (29) were not daycases. 11 remained an inpatient due to post-operative nausea or pain, 3 due to requiring an MRCP, 9 were kept in for monitoring, 2 had intraoperative bleeding, 3 had social issues and 1 required IV antibiotics. 58% of the 29 had afternoon operations. 48% of the 29 had a Nassar grade of greater than 1. 38% of the 29 had a BMI greater than 30. Conclusion Various reasons for a case to not achieve daycase status were found, with the most common being post-operative pain or nausea. It would prove beneficial to educate patients on common post-operative symptoms and focus on managing these symptoms effectively. Pre-operative appointments should aim to explore a patients home setting at the time of the operation and ensure to book inpatient stays for those who require it, in advance. Theatre lists should be optimised by giving high-risk patients morning slots.

Abstract 4137925: Long-term Outcome of Initial Thoracic Endovascular Repair or Medical Therapy in Acute Uncomplicated Type B Aortic Dissection: Real-world Data from a Nationwide Claims-Database in Japan.

Introduction: Thoracic endovascular aortic repair (TEVAR) has emerged as a promising treatment option for patients with type B aortic dissection (TBAD). However, there is a lack of evidence regarding the long-term morbidity of initial TEVAR compared to optimal medical therapy (OMT) in acute uncomplicated TBAD (uTBAD). Objective: To evaluate real-world data(RWD) on the long-term outcome of Japanese patients with acute uTBAD using a nationwide claims database. Methods: This retrospective cohort study utilizes JMDC, a nationwide claims database under Japan's universal healthcare system. We included patients who were initially hospitalized with a diagnosis of acute TBAD. We defined acute uTBAD by excluding those who died within one month, suffered aortic rupture, traumatic thoracic aortic injury, underwent open-chest surgery, experienced stroke or paralysis, or had less than six months of history in the JMDC. Patients who underwent TEVAR within three months of the index hospitalization (TEVAR group) were compared with those who received optimal medical therapy (OMT group). Propensity score (PS) matching was performed based on age, sex, and year of hospitalization. Using the Kaplan-Meier method, we calculated the cumulative rate of all-cause mortality and aorta-related events. Results: Of 18,445 patients diagnosed with aortic disease between January 2005 and December 2020, 641 were included in the study (OMT group: n=580, TEVAR group: n=61). After PS-matching, demographics of the groups (OMT_PSM: n=183 vs. TEVAR_PSM: n=61) were female (12.6% vs. 13.1%), median age (54 years [IQR, 48-60] vs. 54 years [IQR, 50-61]) and follow-up time (18 months [8-32] vs. 19 months [9-32]), respectively. Kaplan-Meier curves for the aortic-related events (Figure1, 2) are shown as long-term outcomes. Conclusions: This study successfully demonstrated that the estimated 5-year aortic-related event rate in acute uTBAD patients undergoing OMT is approximately 20%, demonstrating the relevance of the RWD source. However, the number of death events in the TEVAR and OMT groups was not sufficient to provide statistical power. Therefore, further studies are warranted to evaluate the long-term prognosis of initial TEVAR for uTBAD.

Inflammation associated with monocyte/macrophage activation and recruitment corresponds with lethal outcome in a mouse model of Crimean-Congo hemorrhagic fever

Crimean-Congo hemorrhagic fever virus (CCHFV) causes human disease ranging from subclinical to a fatal hemorrhagic syndrome. Determinants of CCHF pathogenesis are largely unknown and animal models that recapitulate human disease are limited. A recently described mouse model uses a monoclonal antibody (mAb 5A3) targeting the interferon (IFN) alpha/beta receptor to suppress type I IFN responses, making animals transiently susceptible to infection. To advance utility of this model, we investigated effects of challenge route, timing of 5A3 delivery, mouse sex and age, and virus strain on clinical course and outcome. C57BL/6J mice received mAb 5A3 -1, 0, or -1/+1 days post-infection (dpi). Subsets were challenged with CCHFV strain Turkey04 or IbAr10200 subcutaneously or intraperitoneally, and serially euthanized 3- and 7-dpi, when meeting euthanasia criteria or at study completion (14 dpi). CCHFV-IbAr10200-infected mice almost uniformly succumbed to infection, whereas CCHFV-Turkey04-infected mice transiently lost weight but survived. These results were consistent regardless of mAb timing or route of challenge. Viral replication and dissemination were comparable between the two strains at 3 dpi. However, in the plasma and livers of non-survivors, expression of proinflammatory cytokines/chemokines that correspond with macrophage activation and recruitment were significantly elevated. Lethal disease was also associated with elevated levels of macrophage activation marker CD163 in plasma. Further, mouse macrophages were more permissive to IbAr1200 infection in vitro, suggesting tropism for these cells may influence pathogenesis. Our data suggest that early inflammation may be a critical determinant of CCHF outcome and therapeutics to control inflammation may be worthwhile targets for future investigation.

Job satisfaction declines before retirement in Germany.

Job satisfaction has been found to increase with age. However, we still have a very limited understanding of how job satisfaction changes as people approach retirement. This is important as the years before retirement present specific challenges for older workers. We employed a time-to-retirement approach to investigate (i) mean levels of change in job satisfaction in the decade before retirement, and (ii) social inequalities and interindividual differences in change in pre-retirement job satisfaction. Data were drawn from the German Socioeconomic Panel Study (n = 2595). Latent growth curve modeling revealed that job satisfaction declined slightly as people approached retirement, with steeper declines in the very last years before retirement. However, the mean-level decline was very small. Education, age, health, region, marital status, and historical time, but not gender or caregiving mattered for level and change in job satisfaction before retirement. The findings demonstrate the importance of taking a time-to-retirement approach when examining experiences of older workers.

Variability of Loa loa microfilarial counts in successive blood smears and its potential implication in drug-related serious adverse events

BackgroundThe standard method to diagnose Loa loa infection and quantify microfilarial density (MFD) is the microscopic examination of calibrated thick blood smears (TBSs). In 1950, it was noticed that successive L. loa MFD samples from a single capillary puncture could exhibit up to 20% variation. Although loiasis treatment allocation is based on MFD to prevent serious adverse events (SAEs), data on this variability are scarce. There are also no guidelines supporting the collection and analysis of one or two TBSs.MethodsWe assessed the variability of two successive L. loa MFD samples (MFD1 and MFD2), collected from 255 patients. We analyzed the influence of sex, age, weight, heart rate, arterial pressure, body temperature, and sampling time on MFD variability, as well the impact of MFD variability on MFD thresholds relevant to loiasis treatment protocols.ResultsThe MFD2 was found to have increased in 63% (1145/1826) of TBS pairs and to have decreased in 37% (681/1826) of TBS pairs. The MFD2 were on average 28% higher than the MFD1. These variations drove a total of 333 (17.4%) changes in MFD classes according to loiasis treatment protocol, including 210 (11.3%) class increases. TBSs generated from blood samples from subjects with lower MFD (1–1000 mf/ml) or lower mean arterial pressure (MAP; 55–80 mmHg), or from blood samples collected at an earlier hour time-point (10:00–10:59 a.m.) were more subject to MFD2 variability in a multivariate analysis. The MFD relative change was not constant over time for a given person.ConclusionsWe observed a trend towards an increase in MFD2 with an important variability between samples that may impact loiasis treatment allocation. We suggest that systematically sampling at least two successive TBSs might allow better MFD assessments to prevent post-treatment SAEs. Further studies are needed to verify this variability in larger samples as well as confirm the potential explanatory variables identified.Graphical

Seasonal differences of 25-hydroxyvitamin D concentrations in children and adolescents from Mexico City and Metropolitan Area.

Vitamin D deficiency is associated with bone metabolism and immune disorders. Radiation's seasonal variation affects vitamin D status more at the poles. In Mexico, near the equator, there have been reports of 10-20% vitamin D deficiency in children. There is no consensus on the definition of vitamin D deficiency, different organizations consider that a vitamin D level should be above 20 to 30 ng/ml. This study aimed to analyze vitamin D serum concentrations in children and adolescents from Mexico City and the Metropolitan Area (MA) during different seasons. Cross-sectional study in children and adolescents aged 5-20 years from Mexico City and Metropolitan Area, from autumn 2016 to winter 2017. Variables of interest such as anthropometric measurements, food consumption, and physical activity were analyzed. A total of 816 children and adolescents were included. A high frequency of vitamin D deficiency was detected in 40.7% of the sample. The lowest vitamin D status occurred in winter 2016 and winter 2017. We found a higher frequency of vitamin D deficiency during winter in children and adolescents in Mexico City and MA. This risk persisted after adjusting for age, sex, BMI Z-score, milk consumption, physical activity, and screen time.

A Neglected Point: Frailty in Older Adults with Differentiated Thyroid Cancer.

This study investigated the risk of frailty in older adults with differentiated thyroid cancer (DTC) and the effect of thyroid- stimulating hormone (TSH) levels on frailty. This single-center, cross-sectional study included 70 DTC patients aged ≥60 years with stable TSH levels during the previous year while receiving levothyroxine. Frailty was assessed using the fried frailty phenotype (FFP). Anterior thigh muscle thickness was measured by ultrasound, and the sonographic thigh adjustment ratio (STAR) index was calculated. Muscle strength was measured using a hand dynamometer. Physical activity was determined by the physical activity scale for the elderly (PASE). The median (interquartile range) age and follow-up time were 65 years (62 to 71) and 11 years (7.0 to 14.2), respectively. The median TSH level was 1.10 μIU/mL (0.49 to 1.62), and 58.6% of patients were prefrail/frail. Muscle mass and strength were reduced in 35.7% and 17.2% of patients, respectively. TSH levels were lower in those with prefrailty/frailty (P=0.002), low muscle mass (P=0.014), and low strength (P=0.037) than in their normal counterparts. TSH levels correlated negatively with FFP (P= 0.001) and positively with the STAR index (P=0.034). TSH below 1.325 μIU/mL was associated with an increased frailty risk (area under the curve=0.719; P=0.001). Low TSH, female sex, low handgrip strength, and low PASE leisure time scores emerged as independent predictors of frailty (P<0.05). Older adults with lower TSH levels due to DTC are at high frailty risk and have low muscle mass and strength. Therefore, TSH targets should be set based on a comprehensive evaluation with consideration of the risk-benefit ratio.

Challenges and barriers toward conducting research at a tertiary hospital in Saudi Arabia

Background: In healthcare, research is essential for improving disease diagnosis and treatment, patient outcomes, and resource management, while fostering evidence-based practice. However, conducting research in this sector can be challenging, and healthcare workers may face various obstacles while engaging in research activities. Therefore, understanding healthcare workers’ attitudes toward research participation is essential for overcoming barriers and increasing research engagement. In this study, these aspects are examined through the analysis of survey data from a tertiary healthcare institution in Saudi Arabia. Method: Data obtained via a survey conducted between April and November 2022 among the healthcare workers and employees at a tertiary care hospital in Saudi Arabia were analyzed using descriptive and bivariate statistics. Results: The study sample comprised 713 respondents, 61.71% of whom were female, 58.06% were 26–41 years old, and 72.93% had not undertaken any research as employees or affiliates. A significant association was noted between age group and time constraints (p = 0.004) and lack of opportunity for research (p = 0.00), which were among the identified barriers to research participation. A significant association was also found between gender and barriers to pursuing research (p = 0.012). When the 193 (27.07%) participants who conducted research were asked about the challenges they encountered during this process, gender was significantly associated with difficulties in allocating time for conducting research (p = 0.042) and challenges in accessing journals and references (p = 0.016). Conclusion: The study findings highlight the importance of addressing the barriers and challenges in promoting positive attitudes toward research participation among healthcare workers considering their gender and age. In this manner, healthcare institutions can adopt an environment conducive for professional research engagement.

Enhancing preoperative diagnosis of pancreatic ductal adenocarcinoma and mass-forming chronic pancreatitis: a study on normalized conventional MR imaging parameters.

To assess the utility of signal intensity ratio (SIR) in distinguishing between mass-forming chronic pancreatitis (MFCP) and pancreatic ductal adenocarcinoma (PDAC), thereby reducing unnecessary pancreatectomies or delayed diagnosis brought by misdiagnosis. This retrospective study included 170 participants (34 with MFCP and 136 with PDAC) who underwent radical pancreatic surgery and were diagnosed via specimen pathology. The study group was carefully selected with a 1:4 ratio matching for sex, age, and operation time between two entities. T1 SIR, T2 SIR, arterial phase (AP) SIR, portal venous phase (VP) SIR, delay phase (DP) SIR, DWI0-50 SIR, and DWI500-1000 SIR, were calculated by dividing the signal intensity of lesions by that of the paraspinal muscle, serving as a reference organ. Intraclass Correlation Coefficient (ICC) was estimated to evaluate the intraobserver and interobserver reliability. Wilcoxon tests were employed for univariate analysis, and receiver operating characteristic (ROC) curves were generated to determine optimal cutoff points and AUC values for selected predictors. A tenfold cross-validation method was applied to validate the robustness of the results. The ICC demonstrated excellent correlation for both intraobserver and interobserver(ICCs > 0.8). T1 SIR, AP SIR, VP SIR, and DP SIR were significantly lower in the PDAC group compared to the MFCP group, and exhibited good independent predictive properties with the sensitivities of 61.8, 61.8, 70.6, and 73.5%, specificities of 66.2, 68.4, 59.6, and 55.9%, and AUCs of 0.620, 0.659, 0.670, and 0.668, respectively, hovering around 0.7. The tenfold cross-validation confirmed the reliability and robustness of our findings, with consistent AUC, sensitivity, specificity, and 95% confidence intervals over 1000 iterations. T1 SIR, AP SIR, VP SIR, and DP SIR show promise as potential imaging biomarkers for distinguishing between MFCP and PDAC.

Donor age and ischemic time in heart transplantation –implications for organ preservation

IntroductionThe Organ Care System and Non-ischemic Heart Preservation methods have emerged as significant advancements in heart transplantation, designed to mitigate ischemic injury and extend preservation times. However, their high costs and logistical complexities necessitate strategic utilization. MethodsWe evaluated data from 83,761 heart transplants registered in the International Society for Heart and Lung Transplantation registry from 1988 to 2018. Utilizing a Cox proportional hazards model, we explored the influence of donor age and ischemic time on transplant survival. A key innovation of our study is the development of a nomogram to predict post-transplant survival, incorporating both traditional and advanced statistical methods. ResultsThe median age of recipients was 52 years (22% female) and 33 years (31% female) for donors. Analysis revealed a median ischemic time of 3 hours and median survival of 11.5 years across the cohort. The nomogram showed a decline in survival probabilities with increasing donor age, notably from age 40 and more significantly with ischemic times >4 hours. Ischemic times ≥4 hours versus <2 hours were associated with hazard ratio (HR) of 1.2 (95% CI, 1.1-1.3) for donors aged 40-59, a disparity that escalated for donors aged ≥60 (HR: 2.0; 95% CI, 1.5-2.7). ConclusionThis study highlights the importance of careful donor selection and indicates that certain groups, particularly older donors with prolonged ischemic times, might benefit from ex-vivo preservation techniques. The developed nomogram offers a practical tool for clinicians, enhancing decision-making by providing detailed insights into the relationship between donor age, ischemic time, and post-transplant mortality.

Trends in the incidence of young-adult-onset diabetes by diabetes type: a multi-national population-based study from an international diabetes consortium

Population-based incidence data on young-adult-onset type 1 diabetes and type 2 diabetes are limited. We aimed to examine secular trends in the incidence of diagnosed type 1 diabetes and type 2 diabetes with an age of onset between 15 and 39 years. In this multicountry aggregate data analysis, we assembled eight administrative datasets from high-income jurisdictions and countries (Australia, Denmark, Finland, Hungary, Japan, Scotland, South Korea, and Spain [Catalonia]) that had appropriate data available from an international diabetes consortium (GLOBODIAB) describing incidence by diabetes type among people aged 15-39 years from 2000 to 2020. We modelled type 1 diabetes and type 2 diabetes incidence rates using Poisson regression including age and calendar time by sex. During the years 2000-20, there were 349 591 incident diabetes (both types) cases from 346 million person-years of follow-up among people aged 15-39 years. Over time, there was no statistically significant change in the incidence of type 1 diabetes in Hungary and Japan. The incidence of type 1 diabetes significantly increased in Australia, Denmark, Finland, Scotland, South Korea, and Spain, with annual changes ranging from 0·5% to 6·0%. The incidence of type 2 diabetes significantly increased in four of eight jurisdictions (Denmark, Finland, Japan, and South Korea), with annual increases from 2·0% to 8·5%. The magnitude of increase in incidence of type 2 diabetes was greater in Asian than non-Asian jurisdictions. There was no statistically significant change in type 2 diabetes incidence in Australia and Hungary. The incidence of type 2 diabetes significantly decreased in Scotland and Spain, with annual changes of -0·7% and -1·5%, respectively. There is variability in the trajectory of the incidence of young-adult-onset type 2 diabetes among high-income countries or jurisdictions, with a greater evidence of increase in Asian than non-Asian countries. Evolving trends in the incidence of type 1 and type 2 diabetes in young adults call for the ongoing surveillance of diabetes incidence and a greater research focus on this population. US Centers for Disease Control and Prevention, Diabetes Australia Research Programme, and Victoria State Government Operational Infrastructure Support Programme.

Chronotropic Response to Exercise is Decreased in Patients With Congenital Heart Disease Compared to Cardiomyopathy Following Pediatric Heart Transplantation.

Two common indications for pediatric heart transplantation are congenital heart disease and cardiomyopathy. Prior studies suggest differences in chronotropy on cardiopulmonary exercise testing outcomes depending on indication for heart transplantation. We aimed to determine whether the number of pretransplant sternotomies is associated with differences in heart rate response during exercise testing. A retrospective analysis of our institutional pediatric heart transplant data between 2004 and 2022 was performed. Patients were categorized by indication for transplantation into a cardiomyopathy (CM) group if they had a congenital or acquired cardiomyopathy or a congenital heart disease (CHD) group including all other forms of congenital cardiac anatomic abnormalities. CHD patients (n = 40) differed from CM patients (n = 53) by mean number of sternotomies prior to transplant (2.4 ± 1.8 vs. 0.5 ± 0.9, p < 0.001). There were no significant differences in echocardiographic function or catheterization hemodynamics. In cardiopulmonary exercise testing performance, the congenital heart disease group had a significantly higher resting heart rate (91.8 ± 11.2 vs. 86.4 ± 10.2 bpm, p = 0.019), lower percent predicted age-predicted maximal heart rate achieved (78.3 ± 8.5% vs. 83.2 ± 11.4%, p = 0.032), and lower heart rate reserve (68.6 ± 19.8 vs. 84.4 ± 24.0 bpm, p = 0.001) despite a similar age and average time from transplantation. Regression analysis confirmed number of pretransplant sternotomies as a main predictor of heart rate metrics. There is greater chronotropic incompetence in patients who underwent transplantation due to congenital heart disease compared to cardiomyopathy. The groups differ significantly by number of sternotomies, potentially supporting the hypothesis that prior surgical disruption of cardiac innervation may cause decreased chronotropic response to exercise following transplantation.

Grandparent couples’ experiences of family leisure

Guided by the life course approach and the Ecology of Family Experience (EFE) framework, this qualitative study demonstrates how grandparent couples engaged in family leisure with their grandchildren. Through constructivist grounded theory methodology, this study explored the impacts of life course dimensions on grandparent couples’ experiences with family leisure. Semi-structured interviews with 20 individuals (60–75 years of age) from 10 grandparent couples were analyzed at the couple level. Grandparent couples shared how life course dimensions, including chronological age, sociocultural time, and family timing factors, impacted their family leisure experiences. This study supports the relevance of the EFE framework by focusing on similar dimensions with a precision on the role of life course factors on choosing family leisure experiences.

Anesthetic Management of a Child with Frontonasal Encephalocele and Hemifacial Microstomia Syndrome for Repair of Encephalocele and Microstomia Correction

AbstractAnesthetic management of a child with hemifacial microstomia and frontonasal encephalocele can be challenging due to factors such as a difficult airway, associated systemic conditions, young age, and prolonged operating time. Hereby, we outline the intraoperative management of a 3-year-old child undergoing repair of multiple defects requiring multidisciplinary involvement of neurosurgery, plastic surgery, and anesthesia team. In our case, a size 0 mask and hyper-angulated D-blade video laryngoscopy were used to prevent sac compression and facilitate intubation. Blood conservation strategies included tranexamic acid, precise fluid management, and maintenance of normothermia. Extubation was carefully planned, considering blood loss and airway edema, and performed when the child was fully awake, ensuring a stable postoperative period and successful recovery. This report emphasizes the importance of meticulous preoperative assessment, readiness for a challenging airway, efficient management of intraoperative blood loss, and the value of teamwork.

Ethnic minorities who complete cardiac rehabilitation achieve equivalent functional capacity outcomes after cardiac rehabilitation but only half complete

Abstract Background Cardiac rehabilitation (CR) reduces the risk of death and repeat cardiac events and improves multiple patient outcomes. Ethnic minority backgrounds experience significant health disparities, often due to lack of fluency in dominant language and higher rates of cardiovascular disease risk factors. Despite these issues, outcomes for ethnic minorities from CR are rarely differentiated and participation in CR programs infrequently reported. Purpose To compare participation in and exercise outcomes from CR programs for patients from ethnic minorities versus the majority. Methods A secondary analysis from a national CR audit including 2335 CR participants. Ethnic minority was defined as having poor English language fluency requiring an interpreter for CR assessment. Functional capacity was assessed using 6-minute walk test (6MWT) or metabolic equivalent of tasks (METs). Binary logistic regression model was created to identify independent predictors of completion, accounting for baseline variables. Multiple linear regression models were used to determine if ethnic minority status was an independent predictor of change in 6MWT and METs after adjusting for baseline characteristics. Results Of the 2335 participants, 326 (14%) were from ethnic minorities. The mean age was 66.3±12.4 years and 70% males. There were no differences between minority and majority groups in relation to baseline characteristics. The most common referral diagnosis was myocardial infarction (27%), angina (25%), other – arrhythmias, cardiac devices, valve diseases/procedures (24%), and cardiac surgery (24%). Ethnic minorities were half as likely to complete CR (OR 0.49, 95% CI 0.38, 0.65) adjusted for age, sex, diagnosis, minority status, smoking, referral site and wait time (Table 1). Other factors that increase completion likelihood included all other cardiac diagnoses (compared to myocardial infarction as reference) and non-smokers, whereas major referral centre and female sex negatively impacted completion. Patients from ethnic minority backgrounds had less functional capacity at CR entry compared to the majority (379.9±118 versus 430.7±103 metres, p&amp;lt;0.001), though METs were comparable (6.69±2.73 versus 6.46±2.28 mg/kg/min, p=0.69). However, improvements were equivalent for 6MWT: minority 71.03±58.57 versus majority 71.37±61.16 (p=0.96), and for METs: minority 3.01±1.66 versus majority 3.13±1.74 mg/kg/min (p=0.77). Ethnic minority status was not an independent predictor of change in 6MWT and METs after accounting for age, sex, diagnosis, smoking, referral site, and wait time. Conclusion For patients from ethnic minority groups who completed CR, exercise/functional capacity outcomes were equivalent to majority participants, however less than one-in-two completed. CR programs should consider the needs of ethnic minority groups, particularly in relation to language and tailor content and delivery to promote participation and ensure more equitable access.

Association of sodium-glucose cotransporter-2 inhibitor with regression of coronary plaque burden

Abstract Background Sodium-glucose cotransporter-2 inhibitor (SGLT2i), as a novel oral hypoglycemic therapy of type 2 diabetes mellitus (T2DM), has been proved to benefit cardiac function. However, it remains unknown whether SGLT2i has an impact on coronary plaque characteristics. Purpose The aim of this study was to investigate whether SGLT2i was able to improve coronary plaque composition, burden and inflammation [i.e., fat attenuation index (FAI)] using series coronary computed tomography angiography (CCTA) images among T2DM patients with angina pectoris. Methods T2DM patients presenting with angina pectoris admitted at our center were screened. Eligible patients were those underwent first CCTA within 3 months prior to initiating SGLT2i therapy, and repeated CCTA beyond 6 months after the first CCTA. Those patients not treated with SGLT2i underwent likewise longitudinal CCTA tests were propensity score matching in a 1:1 ratio using age, sex and CCTA time interval. Routine CCTA images were assessed for coronary plaque characteristics using dedicated softwares. Paired or unpaired Student’s t test or Mann–Whitney U test were used for comparing coronary plaque characteristics between series CCTA and patients with or without SGLT2i. The relationships between SGLT2i and changes of plaque characteristics was examined using logistic regression analysis. Results After propensity score matching, a total of 196 T2DM patients with angina pectoris were included (mean age, 60.4±9.2 years; male, 69.9%; SGLT2i treatment, 50%). Time interval between baseline and the last CCTA examinations was 400 (343,496) days. In the SGLT2i group, the non-calcified plaque burden [(39.86±14.30)% vs. (36.84±13.86)%, p=0.002)] and low attenuation non-calcified plaque burden (6.62 [4.11,10.13]% vs. 5.78 [3.40,9.28]%, p=0.042) were significantly decreased between two CCTA images. Whereas, in the non-SGLT2i group, there was no difference with regard to non-calcified and low attenuation non-calcified plaque burden between two CCTA images (all p&amp;gt;0.05). Moreover, changes of total plaque burden and non-calcified plaque burden were higher in the SGLT2i group than the non-SGLT2i group (all p&amp;lt;0.05). Importantly, SGLT2i was associated with total plaque volume (odd ratio=0.594, p=0.024) and non-calcified plaque volume regression (odd ratio=0.619, p=0.042) after adjusting for confounding factors. Conclusion SGLT2i significantly regresses coronary plaque burden, in particularly non-calcified plaque. These findings might explain the observed cardio-protective effect of SGLT2i in large trials.

Prognostic value of IL-22 levels and the TH17 pathway in patients with acute myocardial infarction

Abstract Introduction Acute myocardial infarction (AMI) induces a surge in inflammatory cytokines and cells including T helper cells (TH). TH17 cells are activated by pro-inflammatory cytokines such as IL-1, IL-6, and IL-21; they secrete IL-17 and IL-22 to promote neutrophil chemotaxis and to induce pro-inflammatory cytokine secretion from macrophages. Purpose We aimed to explore the prognostic value of the TH17 pathway and its component cytokines in AMI patients. Methods Patients with AMI (STEMI and NSTEMI) were included from the SPUM-ACS cohort (total N=4,787) selecting a time window &amp;lt;24 h from symptom onset to blood sampling before PCI. Patients with malignancies or immunosuppressive therapies were excluded. 160 patients who experienced death (N=85) or recurrent AMI (N=75) within 1-year follow-up (AMI-case) were compared to 152 counterparts with favorable outcome matched for age, sex, AMI subtype, and onset time (AMI-control). 45 healthy blood donors (HD) without cardiovascular disease were added as a reference group. Cytokine levels were reported as median + IQR and were analyzed with multivariate linear regression. Group comparisons were made using the Mann-Whitney U test or Kruskal-Wallis test and multiple comparisons corrected with Dunn’s test. Kaplan-Meier curves were cut off at a median IL-22 level and tested with Log-rank test. Results Our measurement showed correlation among components in TH17 pathway. IL-22 was significantly associated with IL-1β (β=-3.027e-1, p=0.0164), IL-6 (β=5.413e-3, p&amp;lt;0.0001), and IL-21 (β=3.567e-2, p&amp;lt;0.0001), but not with IL-1α or IL-1RA. IL-22 was not correlated with IL-17. Age (median=71.45 vs 71.30 years, p&amp;gt;0.05), percentage of women (23.8% vs 19.7%, p&amp;gt;0.05), and percentage of STEMI (70.6% vs 69.7%, p&amp;gt;0.05) did not differ between AMI-case and AMI-control. AMI-case and AMI-control both showed higher plasma IL-22 levels than HD, whereas there was no difference between AMI groups (Figure 1A). AMI patients who died within 1-year follow-up had higher IL-22 levels than those with recurrent AMI (Figure 1B). Regarding TH17 activation, patients who died had higher IL-17 levels (Figure 1C). Median IL-22 (4.86 pg/mL) levels were tested for predicting outcome: Patients with higher IL-22 levels had more risk for death or recurrent AMI (p=0.0253, Figure 2A). The mortality of patients above median IL-22 levels was higher than those below (p=0.0126); The KM-curves diverged early in less than 1 month after the initial event (Figure 2B). Conclusions Upstream regulators (IL-1β, IL-6) correlated with downstream effectors (IL-22, IL-17) within the pathways involving TH17 cells. Both IL-22 and Il-17 were higher in AMI patients who died within one year than in similar patients who survived. Investigating TH-17- and IL-22-related pathways may be of interest for further investigation in patients with AMI.